Content area
Full Text
ABSTRACT
In recent years, the incidence of tuberculosis (TB) has increased, primarily in developing countries, but also in Europe and North America. The association between TB and human immunodeficiency virus infection is well-documented. In these cases, TB is more likely to be extrapulmonary. The spine is the most common site for skeletal TB. Atypical appearances may be present in immigrants. Plain radiography remains the cornerstone for imaging, but newer cross-sectional modalities such as computed tomography, ultrasonography, and magnetic resonance imaging are becoming increasingly valuable in early and accurate diagnosis. This article reviews the features of musculoskeletal TB and the role that imaging plays in diagnosis and management.
In recent years, the decrease in the incidence of tuberculosis (TB) noted earlier this century has started to reverse. Throughout the world, including Europe, rates of infection have started to rise.1-3 This trend has been attributed largely to the epidemic of human immunodeficiency virus (HTV) infection. Between 6% and 12% of patients with acquired immunodeficiency syndrome (AIDS) have been found to have TB. Furthermore, more than 50% of patients with TB in developing countries may be HTV positive.35 In these patients, the incubation period is shortened. In addition, tuberculosis is more likely to be extrapulmonary in this group.1,2,6 However, musculoskeletal TB is not thought to be disproportionately frequent in HIV-infected individuals.7
Immunosuppression, immigration, social deprivation, and the emergence of drug-resistant strains also have played a part in the changing patterns of the disease.2 Drug-resistant isolates have become increasingly common in the United Kingdom and United States.3 In the United Kingdom, the highest rates of TB are found in Asian immigrants and their families. However, this group of patients has a very low incidence (<1%) of HIV infection.1 Infection in this group is now falling while it is increasing in immigrants from Africa, who are often HIV positive. The greatest increase in TB notification has occurred in innercity London.8
In the developed world, skeletal TB is usually a disease of the elderly.9 In developing countries and among immigrants in the United Kingdom, it is a disease of young adults and children.10
Plain radiography is the primary imaging modality of suspected bone lesions, but newer cross-sectional imaging techniques such as computed tomography (CT), ultrasonography (US), and magnetic resonance...